Bank Draft Application

Bank Draft Application

TO SIGN UP FOR BANK DRAFT AUTHORIZATION
APPLICATIONS WITHOUT LEGIBLE SIGNATURES WILL BE REJECTED
Full Name*

First Name Last Name
Email*
example@example.com
Bank Draft Authorization

I would like to pay my monthly utility bill by bank draft.
Bank drafts draw electronic payment on your bank account each month for your monthly utility bill. You will receive a bill by mail as usual.

Please complete and sign this form. Also, attach a voided blank check. If you have any questions concerning drafts, please call our office at (325) 676-6405.
- Please allow 4-6 weeks for the bank draft to take effect
- Continue to pay your bill as usual until the bill indicates “Paid by Draft”
- The draft(s) will be drawn on the due date(s) indicated on your bill(s)
- The City of Abilene reserves the right to immediately discontinue this service to my utility account(s) should an issue arise from its use
- I may discontinue the use of this service at any time, allowing ten (10) business days from receipt of my request for it to take effect
Name on Bank Account*
Name of Bank
Bank City, State

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Type of Account*

Checking AccountSavings Account
Bank Routing #*
Confirm Bank Routing #*
*Bank Routing Number & Confirm Bank Routing Number must match
Bank Account #*
Confirm Bank Account #*
*Bank Account Number & Confirm Bank Account Number must match
If you have more than one account, please list each account separately. Please list either the Water Account Number or Account Address.
Water Account #1
Water Account Address #1

Street Address

Unit Number

City State / Province

Postal / Zip Code
Water Account #2
Water Account Address #2

Street Address

Unit Number

City State / Province

Postal / Zip Code
Water Account #3
Water Account Address #3

Street Address

Unit Number

City State / Province

Postal / Zip Code
Water Account #4
Water Account Address #4

Street Address

Unit Number

City State / Province

Postal / Zip Code
With my signature below, I authorize the City of Abilene Water Utility Office to draft the bank account listed above for the utility services on the accounts designated on this form until otherwise revoked.
Signature*

Clear
Date*

MonthDay Year
Date
Should be Empty:

Bank Draft Application

Bank Draft Authorization